Peyronie's disease is a condition characterized by the development of fibrous nodules or lumps in the substance of the penis. It is estimated that it afflicts about 1% of the adult male population. A study of the cross section of the penis in the human male shows that the organ has many layers. Peyronie's disease affects the tunica albuginea layer of the penis. It is most common between ages 40 and 70 but no age is exempt. Even boys in their teens with Peyronie's disease have been described. The exact cause of this disease is not known and many theories abound about the probable mechanism of occurrence of the condition.
An association with abnormal scar tissue formation elsewhere in the body, such as the plantar fascia of the foot, known as Lederhose's disease; the eardrum, known as tympanosclerosis; and the palm of the hand, known as Dupuytren's contracture; is well-known. Approximately 10% of patients with Peyronie's disease also have a Dupuytren's contracture or “trigger finger”.
Evaluation of Peyronie's disease addresses not only the penile curvature but also any associated erectile dysfunction, as both of these problems are often present at the same time. Erectile dysfunction may occur because the plaque may interfere with the ability of the muscles within the corpora to compress the veins that drain the penis during an erection. Therefore, blood “leaks” from the penis back into the general circulation, making it impossible to maintain an erection.
Men with Peyronie's disease usually seek medical attention because of painful erections and difficulty with intercourse. Since the cause of the disease and its development are not well understood, doctors treat the disease empirically; that is, they prescribe and continue methods that seem to help and have been used in the past. The goal of therapy is to keep the Peyronie's patient sexually active. Providing education about the disease and its course often is all that is required. No strong evidence shows that any treatment other than surgery is effective. Experts usually recommend surgery only in long-term cases in which the disease is stabilized and the deformity prevents intercourse.
Because the course of Peyronie's disease is different in each patient and some patients experience improvement without treatment, medical experts suggest waiting 1 to 2 years or longer before attempting to correct it surgically. During that wait, patients are often willing to undergo treatments whose effectiveness has not been proven.
Some researchers have given men with Peyronie's disease vitamin E orally in small-scale studies and have reported improvements. No controlled studies have established the effectiveness of vitamin E therapy, however. Similar inconclusive success has been attributed to oral application of para-aminobenzoate, a substance belonging to the family of B-complex molecules.
Researchers have injected chemical agents such as verapamil, collagenase, steroids, and calcium channel blockers directly into the plaques. These interventions are still considered unproven because studies have included low numbers of patients and have lacked adequate control groups.
Steroids, such as cortisone, have produced unwanted side effects, such as atrophy or death of healthy tissues. Another intervention involves iontophoresis, the use of a painless current of electricity to deliver verapamil or some other agent under the skin directly to the plaque.
Radiation therapy, in which high-energy rays are aimed at the plaque, has also been used. Like some of the chemical treatments, radiation appears to reduce pain, but it has no effect at all on the plaque itself and can cause unwelcome side effects. Although the variety of agents and methods used points to the lack of a proven treatment, new insights into the wound healing process may yield more effective therapies in the near future.
Peyronie's disease has been treated with some success by surgery. The two most common surgical methods are removal or expansion of the plaque. This is followed by placement of a patch of skin or artificial material, and removal or pinching of tissue from the side of the penis opposite the plaque, which cancels out the bending effect. The first method can involve partial loss of erectile function, especially rigidity. The second method, known as the Nesbit procedure, causes a shortening of the erect penis.
Some men choose to receive an implanted device that increases rigidity of the penis. In some cases, an implant alone will straighten the penis adequately. In other cases, implantation is combined with a technique of incisions and grafting or plication (pinching or folding the skin) if the implant alone does not straighten the penis.
Most types of surgery produce positive results. Because of complications and many of the phenomena associated with Peyronie's disease (for example, shortening of the penis), however, most doctors prefer to perform surgery only on the small number of men with curvature so severe that it prevents sexual intercourse.
Vacuum therapy only recently has been used to treat Peyronie's disease. Chris Spivey, a surgical physician assistant at Urology Centers of Alabama in Birmingham has been using the Spivey Technique™ for the treatment of Peyronie's disease over a period of time and through a process of adapting vacuum therapy through existing vacuum cylinders used to treat impotence. There is still a need to improve the vacuum therapy techniques for treating Peyronie's disease.